Substance/Medication-Induced Major or Mild Neurocognitive Disorder
DSM-IV In DSM-IV, this disorder is called Substance-Induced Persisting Dementia For more information, see Dementia and Substance-Induced Mental Disorders Diagnostic Criteria A'''. The development of multiple cognitive deficits manifested by both # memory impairment (impaired ability to learn new information or to recall previously learned information) # one (or more) of the following cognitive disturbances: #* '''a. aphasia (language disturbance) #* b'''. apraxia (impaired ability to carry out motor activities despite intact motor function) #* '''c. agnosia (failure to recognize or identify objects despite intact sensory function) #* d'''. disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) '''B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. C'''. The deficits do not occur exclusively during the course of a delirium and persist beyond the usual duration of Substance Intoxication or Withdrawal. '''D. There is evidence from the history, physical examination, or laboratory findings that the deficits are etiologically related to the persisting effects of substance use (e.g., a drug of abuse, a medication). Recording Procedures The name of the diagnosis begins with the specific substance (e.g., alcohol) that is presumed to have caused the dementia. When more than one substance is judged to play a significant role in the development of the persisting dementia, each should be listed separately (e.g., Alcohol-Induced Persisting Dementia; Inhalant-Induced Persisting Dementia). If a substance is judged to be the etiological factor, but the specific substance or class of substance is unknown, the diagnosis is Unknown Substance-Induced Persisting Dementia. Specific Substances Substance-Induced Persisting Dementia can occur in association with the following classes of substances: alcohol; inhalants; sedatives, hypnotics, and anxiolytics; or other or unknown substances. Medications reported to cause dementia include anticonvulsants and intrathecal methotrexate. Toxins reported to evoke symptoms of dementia include lead, mercury, carbon monoxide, organophosphate insecticides, and industrial solvents. DSM-5 Diagnostic Criteria A'''. The criteria are met for major or mild neurocognitive disorder. '''B. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication an acute withdrawal. C'''. The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment. '''D. The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence). E'''. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder. '''Note: If a mild substance use disorder is comorbid with the substance-induced neurocognitive disorder, the clinician should record "mild substance use disorder" before the substance-induced neurocognitive disorder (e.g., "mild inhalant use disorder with inhalant-induced major neurocognitive disorder"). If a moderate or severe substance use disorder is comorbid with the substance-induced neurocognitive disorder, the clinician should record "moderate substance use disorder" or "severe substance use disorder," depending on the severity of the comorbid substance use disorder. If there is no comorbid substance use disorder, then the clinician should record only the substance-induced neurocognitive disorder. For some classes of substances (i.e., alcohol; sedatives, hypnotics, anxiolytics), it is not permissible to record a comorbid mild substance use disorder with a substance-induced neurocognitive disorder; only a comorbid moderate or severe substance use disorder, or no substance use disorder, can be diagnosed. Specify if: * Persistent: Neurocognitive impairment continues to be significant after an extended period of abstinence. Recording Procedures The name of the substance/medication-induced neurocognitive disorder begins with the specific substance (e.g., alcohol) that is presumed to be causing the neurocognitive symptoms. In cases in which a substance is judged to be an etiological factor but the specific class of substance is unknown, the category "unknown substance" should be used. When recording the name of the disorder, the comorbid substance use disorder (if any) is listed first, followed by the word "with," followed by the name of the disorder (i.e., substance-induced major neurocognitive disorder or substance-induced mild neurocognitive disorder), followed by the type in the case of alcohol (i.e., nonamnestic-confabulatory type, amnestic-confabulatory type), followed by specification of duration (i.e., persistent). For example, in the case of persistent amnestic-confabulatory symptoms in a man with a severe alcohol use disorder, the diagnosis is severe alcohol use disorder with alcohol-induced major neurocognitive disorder, amnestic-confabulatory type, persistent. A separate diagnosis of the comorbid severe alcohol use disorder is not given. If the substance-induced neurocognitive disorder occurs without a comorbid substance use disorder (e.g., after a sporadic heavy use of inhalants), no accompanying substance use disorder is noted (e.g., inhalant-induced mild neurocognitive disorder). Differential Diagnosis Individuals with substance use disorders, substance intoxication, and substance withdrawal are at increased risk for other conditions that may independently, or through a compounding effect, result in neurocognitve disturbance. These include history of traumatic brain injury and infections that can accompany substance use disorder (e.g., HIV, hepatitis C virus, syphilis). Therefore, presence of substance/medication-induced major or mild NCD should be differentiated from NCDs arising outside the context of substance use, intoxication, and withdrawal, including these accompanying conditions (e.g., traumatic brain injury).